Posted in psychology, science

Mental Health Month: Substance Use

I’m going to try and write this as coherently as possible. We still have one more week left of Mental Health Month, and this Thursday, Friday, and Saturday (given my brain doesn’t melt from out of my ears) we will be covering the last stretch of diagnoses we could fit in this month: Somatic disorders, eating disorders, and depressive disorders. If you have a story you’d like to share about any of the labels we’ve covered this month, contact me here or on my social media handles (below).

This evening we’ll be covering Substance-related and addictive disorders, with “substance related” excluding any of the typically prescribed psychotropic medications. That seems like a given, but it shouldn’t be; a lot of psychotropic meds can induce mania, depression, panic, and psychosis. This often gets labeled as proof of a disorder, but in the future when we dive more deeply into what kind of industry this is (and how helpful it can be in many circumstances), we’ll talk about how that’s bullshit.

To be frank.

But for now, we’ll talk about what they want to talk about, and that is the illegal substances no agency can make money from.

What we’re talking about here is the big ten: Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids, Sedatives, Stimulants, Tobacco, and unknown.

What Is a Substance Use Disorder?

In order to be classified under this section, an individual has to continue using their choice substance even while recognizing (or not) significant substance-related problems. This is like the alcoholic whose doctor says their liver is fatty and swollen (a sign of cirrhosis) and despite the eventual fatal outcome, the alcoholic continues to drink. This could be because of many reasons. It could be the person is psychologically dependent on the mood alteration provided by the alcohol. Drinking may be the only way to feel “normal” by then. Physically, the person may be dependent on the resulting biochemical reactions of heavy drinking; stopping alcohol suddenly is the same death sentence as cirrhosis of the liver, but quicker. The body becomes so dependent on the substance that the removal of the substance puts the body (the brain mostly) in shock. This is called withdrawal.

It’s the same thing you experience if you stop your medication suddenly: your brain, having gotten used to whatever receptors that medication was binding to, suddenly has a stark depletion in that neurotransmitter and this can cause irregular electrical activity, mood changes, physical changes like heat flashes, cold sweats, muscle aches, etc. Your brain is constantly seeking homeostasis and there are two ways this gets disrupted: ingesting a substance and stopping a substances after long-term use. For those of us who stop, say, antipsychotics, the psychosis that presents itself is not necessarily what would happen if you were substance free. It’s not your “illness coming back”, its the disruption in homeostasis exacerbating your experiences.

Alcohol withdrawal is one of the most dangerous withdrawals and, if I’m still up to date on all my medical understanding of this, the only one in which you have a high chance of dying. I believe it surpasses benzo withdrawal risk. Those in severe Alcohol withdrawal will typically experience Grand Mal Seizures alongside all of the other mental and physical experiences.

How Do These Substances Interact With Our Body?

Benzodiazepines are some of the quickest addictive substances prescribed. Even if you don’t feel psychological dependent on them, you may realize quite suddenly that your body has become very accustomed to them. Some people have stated that even when taking two of their PRN Benzo medication per week for four weeks, their body went through physical withdrawal. The problem with that is benzos also work on GABA receptors, like alcohol. This is why Benzos are often a first choice in easing alcohol withdrawal.

It’s kind of like when they learned Morphine was addictive and synthesized heroin to use as a replacement. That backfired. We just don’t learn.

You can read about that in short-form here. There’s a much more in-depth, dependable review on the history of this on PubMed, I’ve just yet to find it again.

Stimulants, like cocaine, are not addictive as quickly but people still lose their lives to them. They target chemicals like dopamine, serotonin, and norepinephrine, all that handle feelings of pleasure, confidence, and energy.

Opiates target Endorphins, which inhibit both GABA and Dopamine. This stimulates the receptors to increase the amount of dopamine that’s released because there’s not enough in the synapses. This is the same chemical that releases when you exercise.

I’m not up to date on Inhalants, but I’m going to go ahead and say breathing in condensed chemicals probably tears a few cells up in the process.

Hallucinogens, including Acid, are some of the safest drugs, if you want to think of them like that. They still affect the body; some raise blood pressure or cause a racing heart, but their addictive properties are non-existent. These are being studied currently to treat depression, PTSD, and anxiety which means at some point they’ll be monetized, synthesized and eventually ruined. Many have had profound experiences though, and worked through trauma while micro-dosing LSD or being a risktaker and experimenting with one of the most powerful hallucinogens, Ayahuasca. These substances have a rich history in religious ceremony.

Tobacco and Caffeine are very much legal. Tobacco, once used in abundance as a smoking agent, is now full of carcinogens and heavy nicotine doses which trap the user in one of the hardest addiction cycles to break. Caffeine perpetuates anxiety, raises blood pressure, and is also great on cold mornings with a cigarette. So, pick your poison.

Aren’t These All Plants?

The majority of them, yes.

No, that does not make them safe.

Yes, many are not safe in part due to what people put in them.

No, I don’t suggest traveling to South America just to chew on a coca leaf.

Yes, if I didn’t have such bad anxiety, I’d probably be one of those people to travel to South American just to chew on a coca leaf.

Why Can’t People Just Stop?

Some people can, and do.

This is not a problem of disease. It is, however, a problem of weakened and exhausted self-control. This sounds as if it is blaming the user, but it is not.

There was a study I just learned about in a previous course where they tested individuals self-control and whether it could be exhausted. They set a task in front of a set group of people, one by one, and told them one specific instruction: do not eat the cookies, but feel free to have some of the radishes. They set the same task in front of another set group of people, one by one, and told them one specific instruction: have anything you want on the plate.

Those who had to exercise their self-control (by not eating the cookies) had less patience when it came to do the second task, which were some puzzles on paper. Those who did not have to exercise any self-control maintained their base awareness.

This is one of many tasks that shows it may not be indulgence that starts or continues an addiction, but rather a consistent breakdown of self-control; once someone uses a substance, they have went against the cultural norm to NOT use that substance. The physicality of the drug doesn’t make the second time easier, the reduction in self-control does.

There are many ways to continue to test this and could revolutionize how addiction is treated and looked at. It’s not the fault of the person. It’s not a defect in will-power or a weakness. It’s simply exhausting your bandwidth of self-control, which we could all easily do. That’s why addiction has no preference for creed or color.

Some may be genetically predisposed to a shorter self-control bandwidth, not addiction. This is my hypothesis. It’s not disproven, and it probably won’t be any time soon, not by me at least. But having grown up with generations of severe alcoholics behind me, one of which died at 56 because of it, I know what it’s like to feel like your genes might be defective. The truth is, at least between fathers and sons, sons of alcoholics are no more likely to become alcoholics than the average man.

I’m a woman, so I’m not sure of our statistics.

When I was prescribed Percocet for my back injury, the first pill did nothing. So I took two. And had no idea how hard it would hit me. I remember sitting in my research course and the room feeling light as air. My body felt warm and nice and I felt kind, friendly, approachable. I felt social, something I never feel. Then I spent forty minutes trying to keep my eyes awake and my notes were just scribbles. By the end of the class, I’d written nothing worthwhile, and my back still hurt.

But coming out of that I realized how people could get so attached to the feeling. It’s a level of happiness one couldn’t attain naturally, and evolution probably derived that limit for a reason. We’d have no sense, no awareness, no anxiety, no fear. We wouldn’t survive as a species.

I also noticed my need to take more. I told myself no.

I told myself no for two months.

And then I rewarded my self-control with a lack of self-control and two months later my stomach was tore up, I felt I couldn’t make it through the day without at least a half of pill, and I was becoming increasingly dissatisfied with my own natural state of being–the state without the high.

I went into this experimenting; if I focused on my self-control, designated days to take one pill, two pills, a half a pill, one and a half pills, could I sustain myself without becoming attached? And I did for one month until I exhausted that bandwidth; the more times I told myself “no” and then “okay, just take half”, the more likely I was to say “well, half isn’t going to do it, take one and a half.”

So, another way to evaluate this hypothesis would be to ask: is someone more likely to become addicted if they exercise self-control or no self-control? We couldn’t run those trials ethically, but there may be a way to design an experiment without ruining people’s bodies.

I was not addicted. But I felt the pull.

This can happen to anyone, for any reason, at any time, and it’s not a sign of internal weakness or brokenness or some other negative connotation that gets thrown alongside these experiences. We are creatures who often want to alter our moods. We want our anxiety to stop, our depression to ease up, our happiness to never end. We’re a culture ripe for the course of addiction. Think twice before your blame someone for their experiences.

Do Rehabs Really Do Anything?

I’ve never been. They didn’t work for my dad. But they work for many. Some people embrace the programs, like 12 Steps, and swear by it. Others find a different path. Some find no path and succumb to the substance. I’ve only been to an Alanon meeting for myself with a previous therapist and it felt too programed. I’ve went to AA and NA meetings and the cult aspect of it gave me panic attacks. But for those who felt truly touched by the program, there were many success stories and as long as people are living the life of health that they want to be living, I’m not going to knock that.

What About Relapse?

What about it? I hear many people learn new things from their relapses. Don’t get me wrong, these slips can and do kill people. But to regress and then progress and regress again only provides a new insight to the self and a different perspective on life. Relapse is slowly being seen as a natural progression of addiction rather than an added failure of the person.

If we take away the aspect of death (not to minimize it, but for the purpose of this thought experiment) we can think of it as experiencing another depression episode or psychotic episode. We learn more about how we need to care for ourselves. We may have a new respect for friends and family who come through for us. We can look back and see where we slipped up in self-care or evaluate an incident that lead to our regression.

We all fall back into things we don’t mean to. And when we learn to stop attacking ourselves for mistakes we make, we may just give ourselves a chance to heal.

I will be back with Somatic disorders on Thursday. Although, keep your eye out for a post on something a little more personal. I feel the need to express feelings through words. Thank you for reading.

If you want to connect or inquire about sharing your story, catch me here:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. you give me more reason to continue encouraging critical thinking for all.

Posted in psychology, science

Mental Health Month: Personality Disorders

Hey everyone. Welcome to this hour of Mental Health Month. Upon checking my notes, I realized I’ve completely skipped the week of the 18th, where we cover Somatic disorders, eating disorders, and depressive disorders, and went straight into the last week which covers Gender Dysphoria, Neurodevelopmental disorders, and personality disorders. So, I’m switching things around a little.

Yesterday we talked about Gender Dysphoria, the meaning of tolerance, and the realities of biological humans–that is, a brain can indeed develop specifically toward a different sex than the sex of the body. Today, we’re going to talk about Personality Disorders. Tomorrow we will cover Substance-Related and addictive Disorders. The following week will be Somatic disorders, eating disorders, and depressive disorders. We will include Neurodevelopmental disorders on the last day of the month so no one feels left out.

If you want to share an experience you’ve had with any of the above conditions, or even ones we’ve already talked about, feel free to contact me here or on my social media (profiles below).

Now, we come to my favorite section of the DSM-5, with one of the only disorders that has been characteristically diagnosed unreliably–that is, psychologists often come to same conclusions on other disorders but can never quite agree who has this one– and with little to no genetic influence detected. I’m, of course, talking about Borderline Personality Disorder. We’ll get to that shortly. 761

Because personality disorders widely controversial, the DSM constructs this section completely differently. First they describe personality disorders, clinically, as a discrepancy between a persons inner experience/behavior and the expectations of their culture. This is stable over time and generates impairment.

Then, they mention because of the “complexity” of the review process (this is a fancy way of saying because research that correlates these labels with “disordered brains” are inconclusive and scarce), they have split the personality disorder section into two. The second section updates what was in the DSM-4-TR, and the third section has a “proposed research model” for diagnosis and conceptualization.

Personality disorders are separated into clusters still. Cluster “A” disorders are:

Paranoid Personality Disorder: this includes someone with a “pervasive distrust” of others. People’s motives are perceived as malevolent and the individual has a preoccupation with doubts about people’s loyalty, and trustworthiness. There is a constant level of perceiving personal attacks where attacks are not intended and believe that others are exploiting them. This cannot occur during schizophrenia or any other psychotic disorder, including Bipolar mania. They may, however, experience brief psychotic episodes that last minutes or hours. I’ve always thought of this disorder as a miniature schizophrenia.

Schizoid Personality Disorder: This one is actually less harmful in terms of relationships because the person does not form close relationships and has no desire to do so. Not quite sure why that’s a problem. But, they have restricted range of expressed emotions and chooses solitary activities. They may be indifferent to praise or criticism and has a flattened affect. I’ve always thought of this disorder as the negative symptoms of schizophrenia, plus one.

Schizotypal Personality Disorder: This includes issues with close relationships as well but includes cognitive distortions, ideas of references but NOT delusions of reference, odd beliefs, bodily illusions and odd thinking. Paranoid ideation and constricted affect are also included. This cannot occur during the course of other psychotic disorders either, and is probably more of a mini schizophrenia than Paranoid Personality. People often seek treatment for the anxiety and depression rather than their thoughts or behaviors and they may experience psychotic episodes that last minutes to hours.

Cluster “B” Personality Disorders are the ones everyone wants to get their hands on.

And by hands on I mean “grasp an understanding of.”

And when I say Cluster B personality disorders, I really mean just the first two. The others no one seems to mention very often.

Antisocial Personality Disorder: This is not sociopathy. Sociopath isn’t even the correct word. Psychopath is. But that’s not who these people really are. We’ll talk about The Dark Triad next month. It’ll be great fun.

Those diagnosed with Antisocial PD do share some things with clinical psychopaths though, and that is their unyielding disregard for other’s natural rights. This includes breaking the law remorselessly, lying, conning, and being otherwise deceitful for fun or personal gain. It also includes impulsivity, aggressiveness, disregard for other’s safety, and irresponsibility. People must be 18 years old before this diagnosis is concluded and must have evidence of a conduct disorder before 15 years of age. None of these criteria can occur during schizophrenia episodes or bipolar episodes.

Borderline Personality DIsorder: This is the controversial one. It’s described as instability of relationships, self-image, and affects, with a sprinkle of impulsivity and efforts to avoid real/imagined abandonment. Individuals may also be impulsive with self-damaging activities, like reckless driving or spending, binge eating, substance abuse. There may be reoccurring self-mutilation and emotional instability around irritability and anxiety that lists a few hours and rarely more than a few days. Feels of emptiness, intense anger, and severe dissociative symptoms may also occur.

The dissociative symptoms should give a clue to what is one of the number one correlations with this disorder.

75% of diagnoses are female. And with every clinician learning that statistic, more females are likely to be diagnosed with it than actually have it. Across cultures as well, according to the DSM, it is often misdiagnosed.

Histrionic Personality Disorder: Not a commonly heard one, but in reading the description you might think you know someone with this personality type.

These individuals are attention seeking excessively, and very emotional. They need to be the center of attention and are often seductive. They have rapidly shifting expressions of emotions and their speech lacks detail. Everything is a theatrical display.

Narcissistic Personality Disorder: The second of the Dark Triad, which we will talk about next month. This is a pattern of serious grandiosity, fantastical or in behavior, and a need for admiration. There is a severe lack of empathy and these individuals generally want to be recognized as superior without reason. They are obsessed with fantasies of unlimited power, love, beauty, and success. An individual may believe they are inherently “special” and are insanely entitled. They are arrogant and envious.

50-75% are male. Again, these numbers also make it more likely they will be diagnosed with this.

Cluster C Personality Disorders are on the softer end of the spectrum. Softer not in intensity, but in personality. These are the people certain Cluster B types would take advantage of easily.

Avoidant Personality Disorder: This is someone who feels inadequate and hypersensitive to criticism, so much so that they avoid anything that may make them feel inadequate. This includes social gatherings, work, and any other interpersonal situations.

Dependent Personality Disorder: These individuals have a pervasive need to be taken care of. This may lead to serious submissiveness and clinging behavior. They fear making others feel bad, and so they will not disagree with people. Initiating projects on their own is hard, and seeks another relationship as comfort when another relationship ends.

Obsessive-Compulsive Personality Disorder: This is kind of like the umbrella diagnosis of OCD, but more inclined toward only orderliness, perfectionism, interpersonal control, and lists. They really like lists, rules, and organization. Money will be hoarded in case of catastrophe and they may be inflexible about morality, ethics, and values.

There are other personality disorders that may be due to medical conditions or are unspecified/otherwise specified.

What’s Up With Borderline Personality Disorder?

Well, what isn’t up with Borderline Personality?

It’s been the hot button in clinical psychology because of the intensity of emotions these individuals feel. It often results in some psychologists refusing to treat people diagnosed with these conditions. Two out of my six therapists have told me some version of a “horror story” of an anonymous someone diagnosed with BPD who stormed out of an appointment or blew up in anger and then stormed out of an appointment.

I feel this attaches a very negative connotation to this set of experiences. Everyone expects the outbursts, the sudden changes, the unruly emotions, and so when they happen it’s just more affirmation that the individual is out of control. Self-expectations and other’s expectations can play a huge role in behavior, even in those with this condition.

The problem is, psychologists actually really struggle in diagnosing this. Back in my research course I learned that studies showed psychologists are quite confident when they make the diagnosis, but when other psychologists evaluate the same patient, they often don’t come to the same conclusion. This is in comparison to someone with narcissistic personality disorder, where most psychologists came to the conclusion that that diagnosis was fit for that person. This could be for many reasons: the background of the psychologist, the presentation of the person, the interpretations of the psychologist. It could also be, though, that this condition presents varying experiences and that makes it harder to recognize patterns.

Borderline Personality usually comes with a decent set of childhood trauma. This article from 2017 talks about how childhood trauma can affect biological systems that are then connected to the development of borderline personality. This article from 2014 talks about Complex PTSD (which is not a DSM diagnosis) and Borderline personality. CPTSD overlaps a lot with Borderline, and so these researchers question the scientific integrity of CPTSD and the role of trauma in BPD.

It could be that we’ve had it wrong this whole time, that BPD is not in fact a personality “disorder”, but instead a trauma response condition. This switch would require absolute links between BPD and trauma, the likes of which would match with PTSD, and right now we have no absolute links for any mental health anything. So let’s not hold our breaths.

The point is, the experience of BPD are very real. The label and possible cause mean nothing when someone’s life is turned upside down, when relationships are constantly crumbling, when someone blames themselves constantly for “not being normal.”

Let me re-frame: the possible cause is important in the sense that it could change how treatment is approached. But it is not more important than affirming people’s experiences. Right now treatment for BPD includes therapies in which the individual learns to recognize, label, and acknowledge when their emotions are exaggerated, and medications normally meant for other conditions. There are no medications registered solely for the treatment of BPD.

People often see this as a hopeless diagnosis. Because of this, I encourage people to read personal stories from people diagnosed with this condition so you can see that many of these individuals are creative, vibrant, determined, beautiful people in many ways. There’s one personal story and one more here to get you started.

What’s the Difference Between Antisocial Personality and Psychopathy?

Well, one’s in the DSM-5 and the other is a checklist, for starters.

Psychopaths often lead pretty normal lives. The likelihood that you will see them in a therapists office or in the cell of a jail getting diagnosed with something is very, very slim. They are charming people, do very well in life, and no, they are NOT only serial killers. That’s romanticized Hollywood bullshit. They will manipulate, remain remorseless, and often create an abundance of wealth for themselves. C.E.O’s can score quite high on the psychopath checklist.

People with Antisocial Personality have trouble leading normal lives and can find themselves in trouble. They may be erratic and rage-prone, which can catch quite a lot of attention.

Criminals, like gang-members, are not necessarily psychopaths or antisocial. The DSM mentions that Antisocial may be misdiagnosed if someone is fighting for what they believe to be is their survival. Often gangs are comprised of people who feel close to the other members and consider them family, people who believe they are fighting for “the principle of the matter”, for honor, for integrity, for power. They know their lifestyle inflicts violence and fear, but believes there is no other way to live. They are willing to die for their street family.

That is the opposite of antisocial. It is criminal, but not abnormal given the circumstance.

Some people with antisocial personality are also psychopaths. Some people who are psychopaths are serial killers. Both overlaps are rare.

You are safe.

If anyone watches SBSK on Youtube with Chris, they did an interesting interview with someone diagnosed as Antisocial. You can watch it here. Again, sociopath is a clinically incorrect term.

Please. Stop using it.

If you want to share your story this month, here are my social media links:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

If you enjoyed this post, please share, like, and follow ThePhilosophicalPsychotic. I appreciate every reader and commentator. You give me more reason to continue encouraging critical thinking about psychology.

Posted in Community, Emotions, psychology, Therapy

The Living Nightmare that is childhood sexual abuse

*A featured personal story for this MENTAL HEALTH MONTH series*

I’d been in counselling following the breakdown of my relationship with my sons’ dad. It had become excruciatingly painful, revisiting places and feelings I’d long-forgotten so, about eighteen months in, I leftwithout telling my counsellor. I stayed away, despite her letters asking me to return.

However, things were coming back to haunt me. It was like I had this video in my head, fast-forwarding, re-winding over and over, sometimes so fast, it made me feel physically sick. The accompanying thoughts were disturbing and taunting me but, as I had nowhere to turn, these thoughts just amassed and I felt like a volcano, ready to erupt at any moment.

In desperation, I wrote to Linda (my Counsellor) to ask if I could go back to counselling and thankfully, she agreed. At my first appointment back, she said she hoped and thought I would return. I got the feeling she knew there was more than the breakdown of my relationship going on.

However, because I’d kept my dirty secret, together with these revolting thoughts and stomach-turning feelings, inside for so long — It took many months before it all came tumbling out — but I just couldn’t say the words.

I tip-toed around the topic but Linda was good at making me stay on track, patiently asking endless open-ended questions like “and then what happened?” or “and how did that make you feel?” How f*cking stupid was she? I felt angry, so f*cking angry. Right at that moment, I hated the world and everyone in It! And I felt full of rage towards Linda – for making me do this! I hated how she was digging into the filthy pit of my stomach, scraping out the misery, disgust, hatred and fear, one dirty lump after another. Then she turns. She asks, almost sweetly, “Hannah, can you tell me what is making you so angry?”

“Okay, Okay! I was f*cking abused. Is that it? Is that what you want to hear?” I screamed, and “I. was. sexually. Abused! You happy now? Or do you want to hear how he told me touch him, and I did. Okay. I did! And I don’t know why……,”

Zapped of all energy, my screeching gave way to sobbing and whispered apologies to Linda.

Months in and towards the end of one of our sessions, Linda held up a book and I burst into tears. It was the first time I’d ever seen anything in print about what had happened to me. I felt sick, I couldn’t breathe, and I was sobbing uncontrollably. I think I was in shock, I felt shaken and I had a panic attack.

However, once I’d recovered from the panic, I think I felt slightly relieved. It hadn’t happened to just me. Not that I wanted it to happen to anyone else, but others had been through it, come out the other side, and had written a book to help people like me.

That afternoon, I took the book home and was sitting on my bed, feeling slightly dazed and afraid to open it, when my brother walked in. Puzzled at my silence, he sat with me and saw the title of the book. He put his arm around my shoulders, opened the book, and as we read the Preface, we shed silent tears together. I will always remember this moment and I’ll be eternally grateful to my brother.

I continued with the counselling, trying to unravel this mess – this living nightmare of childhood sexual abuse. processing my thoughts and emotions, slowly. For a long time, I hated myself. I hated that it had happened, that I let it happen, that it went on for so long.

I’d known all this stuff for years but refused to confront it. I wasn’t able to push all that stuff to the back of my mind anymore. I’d always hoped that was it; in the past — gone. But it never goes. It does get easier in time.

Catch Caz at: https://mentalhealthfromtheotherside.com

Her twitter: @hannahsmiley

Pinterest board: http://www.pinterest.co.uk/pin/800444533760600123/

If you would like to submit your personal story to be featured this mental health month, contact me here or on Instagram @written_in_the_photo or on Twitter @philopsychotic. We will be covering Schizophrenia, Bipolar, and Dissociation next. If you have anxiety or trauma related stories you’d like to share, message me anyway. We’ll get you featured.

Read today’s post on Trauma here.

Posted in advocacy, Community, psychology, science

Mental Health Month: Anxiety Disorders

Today we start our Mental Health Month series. As a short recap: every Thursday, Friday, and Saturday this month we will be covering different DSM-5 diagnoses, recent research, and featuring personal stories from YOU. This week we’re covering Anxiety disorders, OCD and Related Disorders, and Trauma and Stressor Related Disorders. If you want the FULL LINE UP, click HERE. If you want to submit your story, CONTACT ME, or find my social media handles below.

Now that that’s over, let’s get into today’s topic: ANXIETY DISORDERS.

What Is Anxiety?

We all know feeling anxious isn’t uncommon. It’s simply our body’s natural response to stress. If you look at the state of the world right now, it’s not surprising pharmacies were running out of anxiety medications.

So far, we believe this stress response prompts waves of catecholamines (neurotransmitters like dopamine and epinephrine) which give rise to our flight-or-fight response. From an evolutionary standpoint, this may come in handy if you’re scrounging for food in tiger territory. From a modern standpoint, our sympathetic nervous system is constantly bombarded with new information and new things to worry about. From an epigenetic standpoint, your resulting anxiety from this overstimulation influences the on-off switch in the genes of your child, creating a world of ever-more-anxious, alert, frightened children.

There’s no definitive proof for any of these hypotheses. There is evidence suggesting all sides, and more, but studying humans is hard and concluding one idea over the other might not be practical. Please do not take this ambiguity lightly. Most people want to agree with one of the three hypotheses listed above because it just makes sense to them. This is a trap of confirmation bias.

I find that anxiety becomes a fear of the future, a fear that the present could not possibly (or will exactly) lead to the future, and a fear that the past has ruined the future; anxiety, today, is a summation of fears.

Let’s talk about what happens when this becomes debilitating.

What Is An Anxiety Disorder?

Let’s first consult the DSM-5:

It states, “Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances.”

Not vague at all, right? You’ll learn much of the DSM is vague and simple in a convoluted way that makes diagnosis tricky: much of it is based on the subjective interpretation of the clinician.

There are 11 total anxiety diagnoses in the DSM-5:

1. Separation Anxiety Disorder

2. Selective Mutism

3. Specific Phobia

4. Social Anxiety Disorder

5. Panic Disorder (with panic attack specifier)

6. Agoraphobia

7. Generalized Anxiety Disorder

8. Substance/medication-induced anxiety disorder

9. Anxiety disorder due to another medical condition.

10. Other specified anxiety disorder

11. Unspecified Anxiety disorder

For the sake of the attention span of the average person (including me), we’re going to list the criteria of two of these diagnoses in depth so that you may see how they are broken down.

Let’s run through criteria, and then we’ll talk “causes” and treatment.

Selective Mutism

For this diagnosis, you must have the following (criteria summarized for all of our sake):

A) Consistent failure to speak in situations where there is expectation to do so, like at school.

B) Interferes with education, occupational, social achievement and communication

C) Lasts at least one month.

D) Not attributed to a lack of knowledge or comfort with the spoken language.

E) Not better explained by a communication disorder and does not occur during the course of autism, Schizophrenia, or another psychotic disorder.

These kids will speak in their homes with their immediate family but not with close friends or second-degree relatives—like grandparents. They “refuse” to speak at school, so says the DSM, although I’d argue it’s much more like an anxious reflex, this coming from someone who had this diagnosis; the anxiety is so severe the only option is for the child to shut down.

This also can include “excessive shyness, fear of social embarrassment, social isolation, and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behavior.” It is a “relatively rare disorder”, usually appears before 5 years old, but it may not be obvious until the child enters school. The long-term of this disorder is unknown, and “clinical reports suggest that individuals may ‘outgrow’ selective mutism.”

This next line is what happened to me: “In some cases, particularly in individuals with social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety disorder remain.”

Temperamental factors are not well identified. Environmental factors, such as parents modeling social reticence, can contribute to the development of selective mutism. This may include controlling parents or overprotective parents.

Genetic factors: nothing identified.

Social Anxiety Disorder

For this diagnosis, it’s exactly what you think and some of what you may not have thought of. These criteria have a longer list, so I will summarize in a paragraph:

There must be obvious anxiety about social situations when the person is exposed to possible scrutiny of others, like meeting with unfamiliar people. In children this must be observed with peers and not just adults. The person fears showing anxiety symptoms which could be judged negatively. Social situations always provoke fear. In children, this maybe seen as crying, freezing, tantrums. These situations are avoided or endured terribly—very terribly.

Of course the fear must be deemed out of proportion to the actual threat of the social situation. This lasts for six months or more (like my entire life) and influences impairment in social, occupational, and other areas of life. It’s not attributed to substance use or other medical conditions, and can’t be explained with another disorder.

Apparently, “the duration of the disturbance is typically 6 months” and so I would like a refund please—24 years and counting.

It’s seen that individuals with this disorder might be poorly assertive or excessively submissive or even highly controlling of the conversation. They might not use a lot of eye contact—so parents, don’t worry, your anxious child probably does NOT have autism. They may be withdrawn, and disclose very little about themselves, or speak with an overly soft voice.

They may live at home longer.

Self-medication is common.

The median age of onset is 13 years old. If that average were taken with kids also diagnosed with Selective Mutism, the median age, I’m speculating, would be much lower.

Temperament: The trait of behavioral inhibition (shrinking away from unfamiliar situations) has been linked to the development of this disorder.

Environmental: No increased rates of childhood maltreatment in the development of this disorder, BUT maltreatment is a risk factor.

Genetic: Traits, like behavioral inhibition, are genetically influenced. Social anxiety is heritable (NOT inherited). No specific genetic factors have been identified.

So What Causes Anxiety Disorders?

What’s the first thing that comes to your mind? Trauma? For those of us who have been ingrained in the mental health system for a while, you might think “chemical imbalance”. Not even the DSM endorses that as absolute. You will find that genetic factors are no where near being identified, much less a chemical imbalance.

When tackling this, we must remember that your genes, your body, your cells, your thoughts, are incredibly malleable. When we talk about “predisposition” in relation to genes, we’re talking about the propensity for them to switch on and off. For example, it seems that some genes are more likely to, in response to a traumatic event, turn on.

Every cell in your body is influenced by your environment. This makes it extremely difficult to confirm what is solid at birth—were you doomed to live with anxiety?—and what is developed after birth. In fact, we may never know.

If you Google “what causes anxiety”, you will be lead to proper links citing similar things as the DSM: personality traits with an unknown genetic basis has a large influence.

If you Google “what causes anxiety disorders”, you will be fed a mix of “chemical imbalance like diabetes” and “stress”.

If Anxiety, or any mental health condition, was a chemical imbalance like diabetes, we’d have a psychotropic equivalent to insulin.

If you search for a similar phrase in psychology databases, you won’t find what you’re looking for.

I managed to find an article entitled “Biological markers for anxiety disorders, OCD, and PTSD: a consensus statement. Part 2: Neurochemistry, Neurophysiolgy,, and neurocognition”. If you are interested in it, I only have access through a database, so I can email you the full text.

This paper from the World Journal of Biological Psychiatry summarizes all the current biomarkers (as of 2017) for anxiety disorders, OCD, and PTSD. They state “none of the putative biomarkers is sufficient and specific as a diagnostic tool, [but] an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD, and PTSD.” It cites Serotonin precursors, GABA, Dopamine, Neuropeptides, and even Oxytocin the love neurotransmitter.

My criticism for this starts with their PTSD makers. It states: “Compared with control subjects, PTSD patients showed significantly elevated platelet-poor plasma NE (norepinephrine) levels and significantly higher mean 24 hour urinary excretion of all three catecholamines (NE, Dopamine, HVA).” It cites another study as the source for this, which I can’t find yet. What could other factors be for this rise in stress neurotransmitters? My point: you couldn’t possibly pinpoint this particular rise in catecholamines to PTSD alone because we can’t isolate the PTSD from the rest of the body/brain. Take everything with a grain of salt.

Biomarkers are real. We ARE biological beings, and to ignore that would be, well, ignorant. However, the lack of understanding for how our biology transforms through life means attributing brain states to only chemical differences without connecting the body’s experience of physical life is just as ignorant.

So, we ask, are anxiety disorders a chemical imbalance? The answers is: we don’t know. And we may never know.

Anxiety Disorder Treatments

Medication has been a go-to for years. Benzodiazepines, dangerously addictive and physiologically dependent in a short amount of time (2-4 weeks) do well at cutting panic attacks down for size. Valium, Ativan, and Klonopin have saved me more than once. SSRI’s and SNRI’s, researched for depression and sold for everything else without care, can sometimes help calm anxiety. Lexapro, Effexor, Zoloft, and Trintellix—honestly I couldn’t tell if they did anything at all to my anxiety. But for some people, they work.

Some antipsychotics like Abilify (some, again, sold against the label) are added on to antidepressants with the purpose of easing depression, but can also inadvertently help anxiety and there’s no rhyme or reason for it. It can probably be dedicated to the sedating effect.

Certain therapies, however, have been proven time and time again to be more potent than medication for SOME disorders, and many experiments show a combination of therapy and medication is better than mediation alone or therapy alone. These studies must be scrutinized with care however: some of them have no control group or comparison treatment.

For example, Cognitive Behavioral Therapy has been shown to significantly reduce distress in Panic Disorder and PTSD when compared to medication and no treatment. What will work depends on your willingness to throw yourself into the process. I’ve done much CBT and found that it only started working after I stopped putting off the homework. There are also personalities and onset of the condition that affect this, which you can read about here.

Other treatments are being studied too. We talked about Freespira here, the medication free treatment that is entirely invalid.

There is study going into Chamomile treatment for Generalized Anxiety Disorder. This study concludes there was non-significant reduction in GAD relapse but significantly better GAD symptoms and improved psychological well-being. Part of their funding came from the Nations institutes of health and a cancer center, and the authors have no conflicts of interest. It was a randomized clinical trial. Read it here.

Naturopathic care, including certain vitamins, need more research, but has some success in this article. My criticism is that if the participants were aware that anxiety was being studied, the placebo effect could be huge. I didn’t read through the entire study, admittedly, but if YOU find whether participants were aware or if they were deceived as they should have been, let us know.

Where Can I Get Help?

If you feel you are struggling with anxiety, please reach out. If you don’t have close friends or family, message me.

If you want to speak with someone anonymously, I recommend Peer Support warmlines. These are not hotlines for crisis, but for meaningful conversation with someone who has been there. There is a list at this link. Those are for California, but anyone can call from anywhere. I’ve spoken to people from England before. You can search for some in your own state or region as well.

If you don’t trust any of those, give us a call at 831-688-0967. We are also a peer warm line service where I work, and have gotten calls from people throughout the country. We are open right now, 24/7. We try and keep conversations to twenty minutes, but I’ve been known to stay on longer if nothing else is going on in the house and the person is really needing support. *I will say I won’t necessarily be the person to pick up. We have other staff members.* If something comes up in the house, our current guests are a priority and we may need to get off the phone.

If you choose Therapy, online or otherwise, is another option. I recommend Psychology Today to find a therapist near you, or your health insurance website.

Your general practitioner may also have suggestions. If you choose the medication route, I suggest researching a good psychiatrist, reading your OWN research, and not allowing your general practitioner to run your psychotropic medication case. They are not trained for that.

Our Mental Health Month Featured story is at THIS LINK: Read about Caz and her journey through anxiety and into a mental health nurse career.

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